KASULA's ANAEMIA ASSIGNMENT IN MEDICINE AND SURGICAL NURSING.docx

KASULA's ANAEMIA ASSIGNMENT IN MEDICINE AND SURGICAL NURSING.docx

• 1.
  LEVY MWANAWASA MEDICALUNIVERSITY SCHOOL : SCHOOL OF NURSING PROGRAM : DIPLOMA IN REGISTERED NURSING COURSE : MEDICAL SURGICAL NURSING LECTURER : MR MULUSA STUDENT : CHIKUMO KASULA STUDENT NO. : 230300489 DATE GIVEN : 4th APRIL, 2024. DUE DATE : 9th APRIL, 2024. QUESTION : EXPLAIN THE CLASSIFICATION OF ANAEMIA, ITS PATHOPHYSIOLOGY, STATE THE CLINICAL PRESENTATION AND MEDICAL MANAGEMENT, PREVENTION AND COMPLICATIONS.
• 2.
  INTRODUCTION Anaemia can bedefined as a reduction from normal of haemoglobin in the blood. It does not exist as one disease, but a condition that results from a number of different pathologies. The World Health Organization defines anaemia in adults as haemoglobin levels less than 13g/dl for males and 12g/dl for females. The low haemoglobin levels result in a corresponding decrease in the oxygen-carrying capacity of the blood. Anaemia is possibly one of the most common conditions in the world and results in significant morbidity and mortality around the world, particularly in the developing countries.
• 3.
  CLASSIFICATION OF ANAEMIA Anaemiacan generally be classified in two ways which is according to the 1. Cause 2. Appearance of the red blood cells ACCORDING TO THE CAUSE 1. Haemorrhagic anaemia (Anaemia due to blood loss) 2. Haemolytic anaemia (Anaemia due to excessive destruction of RBCs) 3. Aplastic anaemia (Anaemia due to bone marrow aplasia) 4. Blood forming element deficiency anaemia. (e.g. Iron deficiency anaemia, folic acid and vitamin B12 deficiency anaemia). ACCORDING TO THE APPEARANCE OF THE RED BLOOD CELLS 1. Macrocytic hyperchromic anaemia ( Cell appears larger than normal and appears red usually seen in folic acid or vitamin B deficiency anemia) 2. Microcytic hypocromic anaemia (The cell appear smaller than normal and they appear pale. Usually due to iron deficiency) 3. Normocytic normocromic (The cells are normal in size and colour) Seen an acute blood loss. TYPES OF ANAEMIA 1.IRON DEFICIENCY ANAEMIA • Iron deficiency anaemia is caused by deficiency of the element iron in the body. • Bone marrow needs iron to make hemoglobin. Without adequate iron, the body can't produce enough hemoglobin for red blood cells. • Iron deficiency anaemia is the commonest form of anaemia worldwide and may be present in up to 2 billion of the world's population. • Inadequate dietary iron, impaired iron absorption, bleeding, or loss of body iron in the urine are some of the cause of iron deficiency anaemia. Anaemia may result from a mismatch between the body's iron requirements and iron absorption as iron bound to haem (found in red meat) is better absorbed than iron found in green vegetables. • The presence of phosphates and phytates in some vegetables leads to the formation of unabsorbable iron complexes, whilst ascorbic acid increases the absorption of iron. 2. ANAEMIA OF CHRONIC DISEASE
• 4.
  • This isthe second most common form of anaemia (after iron deficiency). It is associated with a wide variety of inflammatory diseases including arthritis, malignancies, inflammatory bowel disease, HV and other infections. •It is also called as anemia of inflammation • In chronic kidney disease and chronic heart failure, the reduced renal blood flow leads to a decreased production of erythropoietin. • Due to this there is impaired response to erythropoietin and the inflammatory cytokines which leads to a reduction in the availability of circulating iron. • In malignancies, in addition to the anaemia of inflammation, the cytotoxic treatments such as platinum-based therapies also decrease erythrocyte production through their anti-proliferative effects on the bone marrow. 3. APLASTIC ANEMIA • This is a life-threatening anemia caused by a decrease in the bone marrow's ability to produce all three types of blood cells i.e. red blood cells, white blood cells and platelets. • The cause of aplastic anemia is idiopathic, but it's believed to often be an autoimmune disease. Some factors that can be responsible for this type of anemia include chemotherapy and radiation therapy and Some drugs like chloramphenicol, may also depress the bone marrow causing aplastic anaemia • A variety of diseases, such as leukemia and myelodysplasia, a preleukemic condition, can cause anemia by affecting blood production in the bone marrow. • The effects of these types of cancer and cancer-like disorders vary from a mild alteration in blood production to a complete, life-threatening shutdown of the blood-making process. 4. HEMOLYTIC ANAEMIA • In the haemolytic anaemias, there is a reduced life span of the erythrocytes. Anaemia occurs when the rate of destruction of the erythrocytes exceeds their rate of production. • Patients with acute haemolytic anaemia commonly complain of malaise, fever, abdominal pain, dark urine and jaundice. • They have haemoglobulinaemia, hyperbilirubinaemia, reticulocytosis and increased urobilinogen levels in the urine. • Patients with chronic haemolytic anaemia also usually have splenomegaly. • Their anaemia is usually normochromic and normocytic. 5. SICKLE CELL ANAEMIA • Patient with sickle cell disease have a different form of hemoglobin called hemoglobin S.
• 5.
  • HAEMOGLOBIN Shas valine substituted for glutamic acid as the sixth amino acid in the beta polypeptide chain compared with normal haemoglobin. • the membrane of red cell containing haemoglobin S is damaged leads to intracellular dehydration. In addition when patient blood is deoxygenated polymerization of haemoglobin S occurs forming a semisolid gel. • These two factors leads to formation of crescent shaped cell with reduced flexibility thus can block microcirculation. PATHOPHYSIOLOGY OF ANAEMIA In anaemia, the pathophysiology is characterized by a deficit in red blood cells (RBCs), leading to a reduced oxygen-carrying capacity of the blood. The production of RBCs is normally balanced with their destruction to maintain a normal level. However, when the rate of destruction exceeds the rate of production, anaemia occurs. The average lifespan of an erythrocyte (RBC) is around 120 days, after which they are destroyed. When the rate of production cannot keep up with the rate of destruction, there is a decrease in the number of RBCs, resulting in anaemia. Low levels of hemoglobin (Hb), which is the protein responsible for carrying oxygen in the blood, contribute to the reduced oxygen-carrying capacity. With decreased oxygen levels, the body activates compensatory mechanisms to meet the demand for oxygen. One compensatory mechanism is tachycardia, which is an increased heart rate. The body tries to deliver oxygen to tissues by pumping blood at a faster rate. However, sustained tachycardia can lead to cardiomegaly, which is an enlargement of the heart due to hypertrophy of cardiac muscles. This can eventually make the heart less efficient, resulting in various symptoms associated with anaemia. CLINICAL MANIFESTATIONS OF ANAEMIA • fatigue and loss of energy • Dizziness and Pale skin • Leg cramps and Insomnia • Brittle nails and Koilonychia (spoon shaped nails) • Atrophy of the papillae of the tongue • Angular stomatitis • Brittle hair • Dysphagia and Glossitis MEDICAL MANAGEMENT
• 6.
  INVESTIGATIONS  Complete bloodcount test  Blood films test.  Sickle solubity test  Hb electrophoresis: always needed to confirm the diagnosis. TREATMENT  Folic acid 5-10mg od for 14/7.  Ferrous sulphate 200mg bd for 14/7  Iron injections - if the person is very low on iron. e.g.. Inferon 2mls bd for 5/7  Vitamin B12 (by injection) - required for pernicious anaemia.2mls Bd every 2 weeks and maintenance of 1ml for life.  Altering the dose or regimen of regular medications - such as anti-inflammatory drugs, if necessary.  Blood transfusions - if required.  Oxygen therapy - if required.  Surgery to prevent abnormal bleeding - such as heavy menstruation.  Iron injections - if the person is very low on iron. e.g.. Iron dextran 50-100mg  For headache panadol can be given 1000mg tds for 3/7  Antibiotics - if infection is to blame. E.g.. Ampicillin 500mg qid for 5/7 PREVENTION  Anaemia caused by dietary deficiency can be prevented by making sure that certain food groups are consumed on a regular basis, including dairy foods, lean meats, nuts and legumes, fresh fruits and vegetables.  Vegetarians who prefer not to eat any dairy foods (vegans) should consider taking vitamin and mineral supplements regularly.  Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients in the small intestine — such as Crohn's disease and celiac disease — puts you at risk. These should be managed properly to prevent anaemia  Iron and folic acid supplementation during pregnancy: This will help to prevent anaemia during pregnancy.  Prompt and adequate management of infections like malaria: To prevent malaria.  Avoiding of unprescribed drugs: This will help prevent anaemia that may be caused by some drugs like chloramphenicol, Regular deworming. To prevent worm infestation such as hook worm which may cause anaemia.  Child spacing: should be practiced in order to enable the body recover and replace its iron stores before another pregnancy.
• 7.
   Encourage pregnantwomen to attend antenatal and post natal clinic: This will help prevent ante and post partum haemorrhage, thereby preventing anemia. COMPLICATIONS Long term problems lead to complications: every organ is involved. Growth And Development: children below normalweight > delayed sexueal maturation > hormonetherapy. Bones: hip joint replacement may be required due to vaso-occlusion episodes leading to chrinic infarcts. Infection: more common in the tissues which vaso-occlusion occur ex: bones, lungs and kidney. Respiratory: shortness of breath, chest pain and hypoxia > death Renal: chronic tubulo-interstitial nephritis Priapism: unwanted painful erection due to vaso-occulsion. Eye: retinopathy > yearly eye check is required. Pregnancy: impaired placental blood flow spontaneous abortion, intrauterine growth retardation, preclampsia and fetal death. CONCLUSION Anaemia although preventable is a global problem. Anaemia still is the commonest cause of maternal mortality and morbidity in spite of easy diagnosis and treatment, anaemia can be due to a number of causes, including certain diseases or a shortage of iron, folic acid or Vitamin B12. The most common cause of anemia in pregnancy is iron deficiency. The youth needs to be educated about diet, sanitation and personal hygiene.
• 8.
  REFERENCES 1. Allali, S.,Brousse, V., Sacri, A.-S., Chalumeau, M., & de Montalembert, M. (2017). Anemia in children: prevalence, causes, diagnostic work-up, and long-term consequences. Expert Review of Hematology, 10(11), 1023-1028. doi:10.1080/17474086.2017.1354696 2. Cappellini, M. D., Russo, R., Andolfo, I., & Iolascon, A. (2020). Inherited microcytic anemias. Hematology, 2020(1), 465-470. doi:10.1182/hematology.2020000158 3. Halawi, R., Moukhadder, H., & Taher, A. (2017). Anemia in the elderly: a consequence of aging? Expert Review of Hematology, 10(4), 327-335. doi:10.1080/17474086.2017.1285695 4. Liu, K., & Kaffes, A. J. (2012). Iron deficiency anaemia: a review of diagnosis, investigation and management. European Journal of Gastroenterology & Hepatology, 24(2). 5. Newhall, D. A., Oliver, R., & Lugthart, S. (2020). Anaemia: A disease or symptom. Neth J Med, 78(3), 104-110. 6. Partridge, J., Harari, D., Gossage, J., & Dhesi, J. (2013). Anaemia in the older surgical patient: a review of prevalence, causes, implications and management. J R Soc Med, 106(7), 269-277. doi:10.1177/0141076813479580.